Publication: Twin to twin transfusion syndrome
Date
2010
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abstract
Twin to twin transfusion syndrome (TTTS) is a specific condition complicating 10-15% of monochorionic multiple
pregnancy. Intertwin vascular anastomoses and transfusion is a normal event. Syndrome develops when blood flow
is unbalanced. Recent studies suggest a paucity of bi-directional superficial anastomoses failing to compensate for
hemodynamic imbalance resulting from unidirectional transfusion along deeper arterio-venous anastomoses. TTTS is
associated with high rates of perinatal mortality. Acute and chronic forms exist and severity varies. The donor twin
is often smaller, hypovolemic, anemic and develops congestive heart failure. The recipient is usually heavier and
polycythemic. Antenatally, second trimester ultrasound usually detects the condition. Serial amnioreduction is the
recommended therapy. Postnatally, intertwin haemoglobin and birth weight differences along with pallor in one twin
and plethora in the other are helpful in making a diagnosis. Medical care of twins after birth is directed towards problem
related to anemia, polycythemia and hydrops. Review of the syndrome is presented with an illustrative case.
Key words: Twin to twin transfusion syndrome, Neonatal diagnosis, Symptomatic polycythemia, Partial exchange
transfusion
Description
R Bhat
Associate Professor, Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India